Journal Title
Title of Journal: Curr Gastroenterol Rep
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Abbravation: Current Gastroenterology Reports
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Authors: P Urquhart R DaCosta N Marcon
Publish Date: 2013/06/15
Volume: 15, Issue: 7, Pages: 330-
Abstract
The holy grail of gastrointestinal endoscopy consists of the detection in vivo characterization and endoscopic removal of early or premalignant mucosal lesions While our ability to achieve this goal has improved substantially since the development of the modern videoendoscope inadequate visual inspection errors of interpretation and lesion subtlety all contribute to the continued suboptimal detection and assessment of early neoplasia A myriad of new technologies has thus emerged that may help resolve these shortcomings high magnification endoscopes as well as the techniques of dyebased and virtual chromoendoscopy are now widely available while confocal laser endomicroscopy and endocystoscopy optical coherence tomography and autofluorescence imaging are generally applicable only in a research setting Such technologies can be broadly categorized according to whether they potentially afford endoscopists improved detection or realtime characterization of mucosal lesions Enhanced detection of otherwise “invisible” lesions such as a flat area of intramucosal adenocarcinoma within Barrett’s esophagus carries the potential of an endoscopic cure prior to the development into a more advanced or metastatic disease The ability to characterize a lesion to achieve an in vivo diagnosis such as a colonic polyp potentially affords endoscopists the ability to decide which lesions require removal and which can be safely left behind or discarded without histological assessment Furthermore targeted biopsies such as in the surveillance of chronic colitis may prove to be more accurate and efficacious than the current protocol of random biopsies An important caveat in the discussion of developing technologies in early cancer detection is the fundamental importance of a healthcare system that promotes screening programs to recruit atrisk individuals The ideal tool to optimize the use of endoscopy in population screening would be a panel of reliable biomarkers blood stool or urine that could effectively select a highrisk group thus reducing the indiscriminate use of an expensive technology The following review summarizes the current endoscopic imaging techniques available and in development for the early identification of gastrointestinal neoplasia
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